Thyrotoxicosis in Jos, Nigeria: a ten year review.

Abstract

Background
In endemic goitre regions, multinodular goitre is more common as an aetiology of thyrotoxicosis than Grave\'s disease. The Jos Plateau is one of the goitre endemic areas of Nigeria. A 10year prospective study was carried out to determine the aetiology and clinical features of thyrotoxicosis in patients attending the Jos University Teaching Hospital (JUTH).

Methodology
All consecutive patients with thyrotoxicosis seen at the Endocrine Clinic of JUTH during the study period were enrolled into the study. These were clerked and examined for thyrotoxicosis and other systemic disturbances such as thyrocardial disease and atrial fibrillation were also noted. Thyrotoxicosis was confirmed by elevated serum thyroid hormone levels. Patients were diagnosed as suffering from Grave\'s disease, toxic nodular goiter, subacute thyroiditis (SAT) or other conditions. A first generation enzyme- linked immunosorbent assay (ELISA) technique was used to detect TSH, and an ELISA technique was used to quantify T3 and T4 concentrations.

Results.
There were 103 (81 female, 22 male) patients recruited for the study. The mean age (+/-SD) was 38.6 (+/- 13.4) years. There were two peak ages of occurrence: 3rd and 5th decades. 98 (95%) patients had anterior neck swelling, 50% of the patients had weight loss, palpitations were seen in 49% and nervousness in 44%. Goitre was found in 100 (97%) patients, moist palms in 58%, tremors in 52%, tachycardia in 42%.
Toxic nodular goitre was found in 47% and was closely followed by Grave\'s disease with 45%. Other cases of thyrotoxicosis such as subacute thyroiditis and thyrotoxicosis factita were also seen but in fewer patients.
The serum mean (+/-SD) T4 for all patients was 257 (86.7) nmol/L. The serum mean T4 of patients with Grave\'s disease was statistically higher than that of patients with toxic nodular goitre (p<0.01). The serum mean (+/-SD) T3 for all patients was 6.7 (+/-3.68) nmol/L. The serum mean T3 of patients with Grave\'s disease was statistically higher than that of patients with toxic nodular goitre (p<0.05). The serum mean (+/-SD) thyrotropin concentration was 0.4 (+/- 0.58). There was no statistical difference between TSH of Grave\'s disease patients and toxic nodular goitre.
There was a positive correlation between serum concentration of T4 and T3 (r = +0.6869, p< 0.001) and a negative, statistically significant one between the concentration of T4 and TSH (r = -0.4679, p<0.001).


Annals of Nigerian Medicine Vol. 2 (2) 2006: pp. 20-24